Abstract: PD13-05
Sources of Funding: AWP is a K12 scholar supported by a Male Reproductive Health Research (MRHR) Career Development Physician-Scientist Award (Grant # HD073917-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program

Introduction

Testicular cancer (TC) is the most common malignancy among men 15-34 years old, and infertile men are at increased risk for TC. Here, we investigate the costs of screening infertile men for TC, and the cost savings associated with early detection and treatment of TC among infertile men. _x000D_

Methods

Incidence, prevalence and hazard ratios for TC and infertility were extracted from the literature and used to calculate the annual number of TC cases among infertile men. Costs associated with TC screening and treatment were compiled using existing Medicare reimbursement databases and published data. These costs were used to model the costs of screening and treatment of infertile men at risk for TC._x000D_

Results

Using incidence, prevalence and census data, the number of infertile men in the U.S. was calculated to be 2,350,000. Using co-prevalence data, 375 new cases of TC per year were estimated in the infertile male population. Screening using testicular self-examination (TSE) resulted in no cost burden. Prior to treatment, confirmation of the diagnosis of TC in men with testicular masses included tumor markers and scrotal ultrasound; these costs are folded into treatment costs. Early treatment was defined as radical orchiectomy followed by low-dose chemotherapy. Late TC treatment was defined as radical orchiectomy followed by chemotherapy and retroperitoneal lymph node dissection (RPLND), as well as salvage chemotherapy. The total cost associated with early treatment of infertile men diagnosed with TC using TSE was $7,035,394, in contrast with a total cost of $19,350,096 for late treatment of this population. Thus, the cost savings resulting from early detection of TC in infertile men using TSE is approximately $12,314,701 per year._x000D_ _x000D_

Conclusions

Infertile men are at increased risk for TC. We find that early screening for TC among infertile men via TSE can result in early TC detection and significant cost savings resulting from early treatment. Despite U.S. Preventive Services Task Force (USPSTF) recommendations against TSE, TSE among infertile men represents a cost effective means of early TC detection in this at risk population. _x000D_

Funding

AWP is a K12 scholar supported by a Male Reproductive Health Research (MRHR) Career Development Physician-Scientist Award (Grant # HD073917-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program